Okaloosa County BOCC — July 1, 2014 — Change Order and Final Close-out checklist with documents for Airport Police Station — reading text

Exceptions This document does not affect any of the following: Disputed claims for extras in the amount of: $ Signature Claimant's Signature: Le LQ MeL! Claimant's Title: “Yee5 / Bad pi €. Date of Signature: (NAY 2e alee! / \ State of: fF County of: OKA Loosh Sworn to and subscribed before me this Qs day of MAY 2014, Lute foot Notary Public Susan JonVes tY4,, SUSAN JONES ee NOTARY PUBLIC PFS STATE OF FLORIDA rm Comm# EE104615 Expires 7/22/2015 CONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT NOTICE: THIS DOCUMENT WAIVES THE CLAIMANT'S LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS EFFECTIVE ON RECEIPT OF PAYMENT. A PERSON SHOULD NOT RELY ON THIS DOCUMENT UNLESS SATISFIED THAT THE CLAIMANT HAS RECEIVED PAYMENT. identifying information Nama of Claimant: ¥- AGO Fi& € PAY TECT/O a Name of Customer: Son) Co Cr on JobLocaton: Interior Modifications for Police Station,NW FL Reg. Airport Owner: Okaloosa County Conditional Walver and Release This document waives and relaasas lien, stop payment notica, and payment bond rights the claimant has for labor and service provided, and equipment and material dellverad, to the customer on this Job. Rights based upon labor or service provided, or equipment or material delivered, pursuant fo a written change otder that has been fully executed by the partles prior to the data that this documant Is signed by the claimant, are walved and rafeased by this document, unless listed as an Exception below. This document Is effactive only on the clalmant's recelpt of paymant from the financlat institution on which the following eck Is drawn: Makerof Check: Ory + Son Conveaue rina) AmountofCheck: $ /SY3.00 _ faid in ful Check Payable ta: Serr co Fre. be okchty) 4 Exceptions This documont does not affect any of tha following: Disputed claims for extras in the amountof$ ) “sy Signature Glalmant’s Signatures GY Prn CRAAO Claimant's Titles Sterne tan, DateofSignatura: = £5- DF-Heery State of: PL county of: Walton Sworn to and subscribed hefere me chia ep day of Ati 2014. YN si a ff : KOMBERLY CAMPBELL ADKINSON i + hbk C Ab bet, NOTARY PUBLIC Notary Public PeeAMeHS Comment FFO9G242 ESTATE OF FLORIDA CONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT NOTICE: THIS DOCUMENT WAIVES THE CLAIMANT'S LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS EFFECTIVE ON RECEIPT OF PAYMENT. A PERSON SHOULD NOT RELY ON THIS DOCUMENT UNLESS SATISFIED THAT THE CLAIMANT HAS RECEIVED PAYMENT. identifying Information Nave ofGiament Bit Burch Building Sales »xwe- Name of Customer: (9 pdt € SOM) Coast Aved For Job Location: Intexioxr Modifications for Police Station,NW FL Reg. Airport Owner: Okaloosa County Conditional Waiver end Release This document waives and releases lien, stop payment nolice, and payment bond rights the claimant has for labor and service pravided, and equipment and material delivered, to the customer on thie job. Rights based upon fabor or service provided, of equipment or material delivered, pursuant to a written change. order that has been fully executed by the parties prior to the date that thia document Is algned by tha claimant, are walved and released by this document, uniess listed a3 an Exception below. This document {s affective only on the claimant's raceipt of payment from the financlal inatitution on which the following chack Is drawn: Maker of Check: Lard € Soa Contteucti an Amountof Check: $ 19 6.10 Check Payablato: Ait bureda bye 1d j as Sales Exceptions This document does not affect any of the following: Disputed claims for extras in tha amount of: $ Signature Claimant's Signature: “~ Pinal a bod (FPA) Date of Signature: S/28 /] Y state of: Flot eda County of: ESCANMALIA Sworn to and subscribed before me this2-{-Haday of May 2014. Notary Public CONDITIONAL WAIVER AND RELEASE.ON FINAL PAYMENT NOTICE: THIS DOCUMENT WAIVES THE CLAIMANT'S LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS EFFECTIVE ON RECEIPT OF PAYMENT. A PERSON SHOULD NOT RELY ON THIS DOCUMENT UNLESS SATISFIED THAT THE CLAIMANT HAS RECEIVED PAYMENT. Identifying Information — Name of-Glaimant: WARREN Hollow Me7TAc DoeeRS. + FRAMES | NameofCustome: Logp & SION ComsTRVET(oaA Job Location: Interior Modifications for Police Station, NW FL Reg. Airport Owner: Okaloosa County Conditional Waiver and Release This document waives and releases lien, stop payment notice, and payment:bond rights the claimant has for labor and service provided, and equipment and material delivered, to the customer.on this Job.Rights ‘based upon labor or service provided, or-equipment or material delivered, pursuantto a written change order that has been fully executed by the parties prior-to the date that this document Is signed by the claimant, are waived and released by this document, unless listed as an Exception below. ‘This-document is effactive only on the claimant's receipt of payment from the financial institution on which the following - Gheck Is drawn: Maker of Check: Mac Pq te A Ca | Amount of Check: § Check Payable to: Exceptions This document does not affect any of the following: Disputed claims for extras in the amount of; $ Signature Claimant's Signature Qn. Rye ae Claimant's Tile: § Senor an Anat ' Date of Signature: SS 3\ 2). 2018 State of: County of: Sworn to and subscribed before me this 6. day of At tf 4 2014, ., LORI A MONTGOMERY MY COMMISSION #FF021807 o } EXPIRES June 12, 2017 . (40 or os " SiorldaNotaryService.com Notary Public Bid No. AP 12-14 FINAL WAIVER OF LIEN To All Whom It May Concern: WHEREAS, the undersigned has been employed by (a)__ Okaloosa County to Interior Modifications for Police Station, NW FL Reg. Airport furnish labor and materials for (b) work, under a contract (c) dated 1/15/2014 for the improvement of property described as (d) Police Station of the. NW FL Regional Airport inthe County of __ Okaloosa , State of FLORIDA of which Okaloosa County __. is the Owner, NOW, THEREFORE, this 27th day of May ,20_14, For and in consideration of the sum of (e) $8,256.34 _ paid simultaneously herewith, the receipt whereof is hereby acknowledged by the undersigned, the undersigned does hereby waive and release any lien rights to, or claim of lien with respect to and on said above-described premises, and the improvements thereon, and on the monies or other considerations due to become due from the owner, on account of labor, services, material, fixtures, apparatus of machinery heretofore or which may hereafter be furnished by the undersigned to or for the above-described premises by virtue of said contract. (f__ Lord & Son Construction, Inc. (SEAL) (Name of~s¢le ownership, corporation or partnership) (Affix corporate seal here) Leven D. Lord (SEAL) — (Signature of Authorized Representative) TITLE: President INSTRUCTIONS FOR FINAL WAIVER (a) Person or firm with whom you agreed to furnish either labor, or services, or materials, or both. (b) Fill in nature and extent of work; strike the word labor or the word materials if not in your contract. (c) If you have more than one contract on the same premises, describe the contract by number if available, date and extent of work. (d) Fumish an accurate enough description of the improvement and location of the premises so that it can be distinguished from any other property. (e) Amount shown should be the amount actually received and equal to total amount of contract as adjusted. (f) If waiver is for a corporation, corporate name should be used, corporate seal affixed and title of officer signing waiver should be set forth; if waiver is for a partnership, the partnership name should be used, partner should sign and designate himself as partner. Bid No. AP 12-14 CONTRACTOR’S RELEASE OF LIENS STATE OF: Florida COUNTY OF: Okaloosa Before me, the undersigned Notary Public in and for the said County and State personally appeared Leven D. Lord II representing the Contractor, Lord & Son Construction, Inc. who being duly sworn according to law deposes and says that all labor, materials, and outstanding claims and indebtedness of whatever nature arising out of the performance of the Contract with Okaloosa County ; the Owner, for Interior Modifications for Police Station NW Florida Regional Airport Contract No. C14-2151-AP , have been paid in full and that for the final payment in the amount of §__ 8,256.34 , the Contractor releases and discharges the Owner and his authorized representatives from any liens or claims of any nature because of or arising from this contract and/or its performance, which it VA. have in the future. By: Leven D. Lord Il, President LF rl a Sworn to and subscribed before me this day of 1o (Notary Public) JANIS A MORE COMMISSION # EE158329 EXPIRES JAN 27 2016 BONDED THROUGH RL INSURANCE COMPANY My Commission Expires: _ /-*+7-/% Bid No, AP 12-14 ADVERTISEMENT OF COMPLETION Lord & Son Construction, Inc. PO Box 1808, Fort Walton Beach, FL 32549 (Contractor) (Address) Interior Terminal Modifications for gives notice of completion of and sets _ April 27, 2014 as the date of final settlement. Police Station at NW FL Regional Aitpottp ro ject) All persons and firms should file all claims for payment to the below address prior to the settlement date: Okaloosa County (Owner) ATTN: Contracts and Leases Coordinator 602-C North Pearl Street Crestview FL 32536 By: Leven D. Lord II Aly tbe President Leg: March 27, 2014 (Title) (Publication Dates) April 3, 2014 April 10, 2014 April 17, 2014 Interior Terminal Modifications For Police Station Northwest Florida Regional Airport C 13 of 14 Sample Contract and Forms _ October 2013 NORTHWEST FLORIDA D News Published Daily Fort Walton Beach, Florida Distributed in Okaloosa, Santa Rosa & Walton Counties State of Florida, County of Okaloosa Before the undersigned authorized personally appeared Colleen Cadogan : who on oath says that (s)he is Legal Advertising Clerk of the Northwest Florida Daily News, a daily newspaper published at Fort Walton Beach, in Okaloegaxounsy, Florida; that the attached copy of advertisement, being a in the matter of Notice Advevtismaunt of Comp tian in the ( \ ale )OSOX County Court was published in said newspaper in the issues of Maxdn 277, 2014 Pron iO. 11) 2014 Affiant further says that the said Northwest Florida Daily News is a newspaper published at Fort Walton Beach, in said Okaloosa County, Florida, and that the said newspaper has heretofore been continuously published in said Okaloosa County, Florida, each day, and has been entered as second class mail matter at the post office in Fort Walton Beach, in said Okaloosa County, Florida, for a period of one year next preceding the first publication of the attached copy of advertisement; and affiant further says that (s)he has neither paid nor promised any person, firm or corporation any discount, rebate, commission or refund for the purpose of securing this advertisement for publication in the said newspaper. STATE OF FLORIDA COUNTY OF OKALOOSA / and: firmsshoutd ‘fila’ aft | ‘claims. for’ payment -to | the -below’ address prior fo the settlement date, ffirmed) before me this I \ HT é 0 | UW Subscribed and sworn to (0 | \ Date) by ACI > who is/are personally known to me or has/have produced Personally Known as identification. (Type of identification} Et. Ll (Signature) “ Notary Public, Commission No. (Name of Notary typed, printed or stamped) ELEANGR HYPES _ Notary Public - State of Florida » My Gomm. Expires Jul 30, 2015 s Commission # EE 116319 i { A Banded Through National Notary Assn. j FUE ASIEN RE Mp | OKALOOSA COUNTY AND. LEASES. COOR- Legal 5863° 0° eon — ee { 802-6 “NORTH -p ADVERTISEMENT or ~ | STREET 0 ARE COMPLETION : | CRESTVIEW: ELor: Notice is ‘hereby “given | !DA 32536 =. cae that’ Lord & Son Con-{ 9 0 ' Sfruction, Ine.; 19° David ; St; Fort Walton. Beach.- FL. 32847" has’ com: pleted” the ° Contract | for Renee ra dl TE | : MODIFICATIONS